Treatment Of Female Sexual Dysfunction Research Articles

History of the Treatment of Female Sexual Dysfunction(s).

This article reviews the history of the treatment of women's sexual problems from the Victorian era to the twenty-first century. The contextual nature of determining what constitutes female sexual psychopathology is highlighted. Conceptions of normal sexuality are subject to cultural vagaries, making it difficult to identify female sexual dysfunctions. A survey of the inclusion, removal, and collapsing of women's sexual diagnoses in the Diagnostic and Statistical Manual of Mental Disorders from 1952 to 2013 illuminates the biases in the various editions. Masters and Johnson's models of sexual response and dysfunction paved the way for the diagnosis and treatment of women's sexual dysfunctions. Their sex therapy paradigm is described. Conceptions of and treatments for anorgasmia, arousal difficulties, vaginismus, dyspareunia, and low desire are reviewed. The medicalization of human sexuality and the splintering of sex therapy are discussed, along with current trends and new directions in sexual health care for women.

Sexual Function Post-Breast Cancer.

The consequences of estrogen deprivation and therapeutic interventions such as radiation, chemotherapy and surgery have a significant negative impact on libido, sexual arousal, orgasmic function and the ability to have pleasurable intercourse. Evaluation and treatment of female sexual dysfunction is a significant unmet need in the breast cancer survivor in spite of the availability of safe and effective treatments.

PNM-13 The Role of Buopropion in the Treatment of Female Sexual Dysfunctions: Literature Review

Throughout the last ten years, women have more frequently sought solutions for problems associated to their sexual function. Among the innumerable factors related to female sexual dysfunctions, depression is usually associated to hypoactive sexual desire and other dysfunctions. It is not clear enough yet how the treatment of depression can restore the sexual function. There are more researches about the effects of antidepressants (especially the serotoninergic ones), which can affect sexual desire and excitation. On the other hand, there are limited studies on the efficacy of the antidote (or additional antidepressant), like Buopropion and Mirtazapine, which reduce the impact on the sexual function. This study aimed to assess whether the medical treatment using Buopropion influences the treatment of female sexual dysfunctions. the bibliographical survey was carried out through Pubmed, Scielo and Academic Google in search of recently published articles. Nine articles were selected for analysis, all of which approached the use of Buopropion by women suffering from sexual dysfunctions. Four of them were developed with depressed women who had already been using SSRIs.

O-05 What Do Men in the Amazon Region Know About the Treatment of Female Sexual Dysfunctions?

Women are more susceptible to experience sexual dysfunctions due to several biological, psychological and sociocultural factors. Approximately 51% of Brazilian women experience sexual dysfunctions. According to DSM-5, partnership is one of the most important factors to be analyzed before diagnosing sexual dysfunctions in women. A multidisciplinary approach, including contributions from gynecology, psychotherapy and urogynecological physiotherapy, is indispensable to recover the patients’ sexual function. However, such approach is neglected by many practitioners and unknown to many heterosexual women and their partners in the Western Amazon Region. This study aimed to assess the knowledge of heterosexual men about the treatment of female sexual dysfunctions and the role of urogynecological physiotherapy in the multidisciplinary approach. 71 heterosexual men (28± 8 years) participated in the research, all of whom were in a relationship for at least 1 year. The men filled in two questionnaires and participated in semi-structured interviews, as part of a cross-sectional mixed-methodology research.

Time-Frequency Analysis of Increases in Vaginal Blood Perfusion Elicited by Long-Duration Pudendal Neuromodulation in Anesthetized Rats

Female sexual dysfunction (FSD) affects a significant portion of the population. Although treatment options for FSD are limited, neuromodulation for bladder dysfunction has improved sexual function in some women. A few studies have investigated peripheral neuromodulation for eliciting changes in vaginal blood flow, as a proxy for modulating genital sexual arousal, however results are generally transient. Our central hypothesis is that repeated or extended-duration pudendal nerve stimulation can elicit maintained vaginal blood flow increases. Under ketamine anesthesia, the pudendal nerve of 14 female rats was stimulated at varying frequencies (1-100 Hz) and durations (0.15-60 min). Vaginal blood perfusion was measured with a laser Doppler flowmetry probe. Changes in blood perfusion were determined through raw signal analysis and increases in the energy of neurogenic (0.076-0.200 Hz) and myogenic (0.200-0.740 Hz) frequency bands through wavelet analysis. Additionally, a convolution model was developed for a carry-over stimulation effect. Each experiment had significant increases in vaginal blood perfusion due to pudendal nerve stimulation. In addition, there were large concurrent increases in neurogenic and myogenic frequency-band energy in 11/14 experiments, with an average maximal response at 31.3 min after stimulation initiation. An effective stimulation model with a 30-min carry-over effect had a stronger correlation to blood perfusion than the stimulation period itself. Repeated or extended-duration pudendal nerve stimulation can elicit maintained increases in vaginal blood perfusion. This work indicates the potential for pudendal neuromodulation as a method for increasing genital arousal as a potential treatment for FSD.

Effects of Mindfulness-Based Therapies for Female Sexual Dysfunction: A Meta-Analytic Review

Mindfulness-based therapy (MBT) represents a potentially efficacious treatment for female sexual dysfunction (FSD). A number of recent trials assessing MBT for FSD have been published, but we are aware of no existing meta-analysis synthesizing these results. We conducted a literature review to identify all published trials of MBT for FSD. References of retrieved studies were searched and key authors were contacted with requests for complete but unpublished trials. Eleven trials, including a total of 449 participants, were identified. Two of these studies were under review at the time of the current analyses. Four trials utilized wait-list controls. All aspects of sexual function and subjective sexual well-being exhibited significant improvement during MBT, with effect sizes generally moderate. Controlled effect sizes versus wait list were of similar magnitude in most cases; however, they did not reach statistical significance for multiple outcome measures. Results for some outcomes were consistent with possible publication bias. For some outcomes, larger effect sizes tended to be reported in studies requiring participants to be in a romantic relationship or studies providing individual (versus group) therapy. MBT may be an efficacious intervention for FSD. However, important limitations of the current literature and future directions for research are discussed.

Is testosterone important for women as they age?

In women, is testosterone an obligatory precursor for extra-gonadal estradiol production after menopause, and has important direct androgenic genomic and nongenomic effects. Testosterone levels in women decline with age from the 4th decade, reaching a nadir in the 7th decade of life. Testosterone levels are positively associated with sexual function in women, and multiple randomised placebo-controlled trials have shown that testosterone therapy can be effective for the treatment of female sexual dysfunction in postmenopausal women. However, low testosterone in ageing women has multiple potential undesirable consequences that have been somewhat ignored. In the brain, testosterone exhibits neuroprotection against oxidative stress, serum deprivation-induced apoptosis and soluble amyloid beta toxicity, and clinical trials suggest exogenous testosterone enhances cognitive performance in postmenopausal women. Lower free testosterone in older women is associated with a decline in bone mineral density and a greater risk of hip fracture. Observational studies implicate testosterone as having favourable cardiovascular effects measured by surrogate outcomes, however associations between endogenous testosterone and CVD risk, and total mortality, particularly in older women are yet to be established.

PD44-12 FEMALE SEXUAL DYSFUNCTION TREATMENT: A META-ANALYSIS OF THE PLACEBO EFFECT ACROSS RANDOMIZED CONTROLLED TRIALS

You have accessJournal of UrologySexual Function/Dysfunction: Female1 Apr 2017PD44-12 FEMALE SEXUAL DYSFUNCTION TREATMENT: A META-ANALYSIS OF THE PLACEBO EFFECT ACROSS RANDOMIZED CONTROLLED TRIALS James M. Weinberger, Justin Houman, Ashley Caron, Avi S. Baskin, A. Lenore Ackerman, Karyn S. Eilber, and Jennifer T. Anger James M. WeinbergerJames M. Weinberger More articles by this author , Justin HoumanJustin Houman More articles by this author , Ashley CaronAshley Caron More articles by this author , Avi S. BaskinAvi S. Baskin More articles by this author , A. Lenore AckermanA. Lenore Ackerman More articles by this author , Karyn S. EilberKaryn S. Eilber More articles by this author , and Jennifer T. AngerJennifer T. Anger More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2069AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Female Sexual Dysfunction (FSD) is a highly prevalent disease that has an immense impact on personal relationships and quality of life. The literature describes various treatment modalities with mixed effects across the four domains: hypoactive sexual desire disorder, arousal disorder, orgasmic disorder, and sexual pain disorder. The limited efficacy of medical treatment likely speaks to a significant psychological component of the disease. The purpose of this meta-analysis of randomized controlled trials (RCTs) was to quantify the placebo effect of various pharmacologic modalities for FSD. METHODS Utilizing MOOSE guidelines, we conducted a systematic review of PubMed®, EMBASE®, clinicaltrials.gov, and the Cochrane Review databases. Using search terms ″female sexual dysfunction″ and ″treatment,″ in combination with ″vulvovaginal atrophy,″ ″vaginismus,″ ″vaginal atrophy,″ ″vulvodynia,″ and ″vestibulitis,″ 603 relevant articles were retrieved. Twenty-two RCT′s met initial inclusion/exclusion criteria and included a placebo arm. Of these, eight studies that utilized the primary outcome measure, the Female Sexual Function Index (FSFI), were ultimately selected for meta-analysis. The placebo effect on FSFI was compared to the respective study′s treatment effect using inverse-variance weighting in a random effects analysis model. RESULTS Across the eight studies, 1,723 women with clinical pretreatment FSD received placebo. 2,236 women were in the treatment arm of the respective studies and received various pharmacologic interventions including flibanserin, bupropion, onabotulinum toxin A, intravaginal Prasterone, intranasal oxytocin, ospemifene, and bremelanotide. Women receiving placebo improved 3.62 [95% CI: (3.29-3.94)] on the FSFI (Figure 1). The treatment arm had a corresponding increase of 5.35 [95% CI: (4.13-6.57)]. CONCLUSIONS This meta-analysis of Level 1 evidence demonstrates that 67.7% of the treatment effect for FSD is accounted for by placebo. This is consistent with the current literature. Further, this study suggests that the current treatments for FSD are, overall, minimally superior to placebo alone which reinforces the significant psychosocial element of the disease process in women. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e884 Advertisement Copyright & Permissions© 2017MetricsAuthor Information James M. Weinberger More articles by this author Justin Houman More articles by this author Ashley Caron More articles by this author Avi S. Baskin More articles by this author A. Lenore Ackerman More articles by this author Karyn S. Eilber More articles by this author Jennifer T. Anger More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Usefulness of ambulatory blood pressure monitoring to assess the melanocortin receptor agonist bremelanotide.

Melanocortin receptor agonists that bind to the melanocortin receptor 4 may cause increases in blood pressure (BP). Bremelanotide is an on-demand, subcutaneous melanocortin-receptor agonist that binds to the melanocortin receptor 4 and is being developed for the treatment of female sexual dysfunction. We studied the effects of bremelanotide administration on ambulatory BP and heart rate (HR), in a randomized, double-blind, placebo-controlled, and parallel-arm trial of three doses of bremelanotide (0.75, 1.25, and 1.75 mg) in 397 premenopausal women with female sexual dysfunction with normotension or controlled hypertension. Pharmacokinetic exposure was assessed in conjunction with ambulatory BP measurements. Increases in ambulatory SBP relative to placebo of 2.4 and 3.0 mmHg (1.25 mg; P values: 0.029 and 0.076) and 3.1 and 3.2 mmHg (1.75 mg; P values: 0.006 and 0.027), respectively, occurred following two doses, separated by 24 h at the 0 to 4-h postdose interval; peak increases typically lasted less than 15 min. Similar increases in the DBP were observed. Increases in BP were accompanied by reductions in HR during the 0-4-h interval for the 1.75-mg dose (-4.6 to -4.7 bpm; P < 0.001). Twenty-six participants discontinued after randomization due to prespecified increases in BP but the proportions were similar among the four treatment groups. These data show that ambulatory monitoring was a useful methodology to detect small, transient increases in ambulatory BP accompanied by reductions in HR following bremelanotide. Results of this trial led to appropriate in-clinic BP monitoring during the larger clinical development trials of this agent for female sexual dysfunction.

014 A Phase 2 Program on Female Sexual Arousal Disorder and Hypoactive Sexual Desire Disorder: Patient Characteristics and Implications for Diagnosis and Treatment of Female Sexual Dysfunction

014 A Phase 2 Program on Female Sexual Arousal Disorder and Hypoactive Sexual Desire Disorder: Patient Characteristics and Implications for Diagnosis and Treatment of Female Sexual Dysfunction

PS-02-012 Oxytocin treatment of the female partner improves sexual function and depression in untreated men

OXYTOCIN TREATMENT OF THE FEMALE PARTNER IMPROVES SEXUAL FUNCTION AND DEPRESSION IN UNTREATED MEN Sheikh Rezaei, S.; Muin, D.; Wolzt, M.; Luger, A.; Bayerle-Eder, M. Medical University of Vienna, Austria Objective: To assess sexual function and life quality in men whose female partners are under treatment for female sexual dysfunction with oxytocin. Methods: Open prospective cohort and questionnaire study on male partners of 30 pre-and postmenopausal women with female sexual dysfunction held at the Department of Clinical Pharmacology,Medical University of Vienna, Austria. Over 22 weeks, men were asked to fill in questionnaires at baseline and after 3 and 5 months, respectively, including Sexual Life Quality (SLQ), Sexual Activity Record (SAR), Partner Performance Questionnaire (PPQ) andHamilton Depression Scale (HDS). Medical and sexual history were obtained, a urological examination excluded erectile dysfunction, sexual abuse, psychiatric diseases, untreated sexual dysfunction and therapy with negative side effects on sexual function. Results: Body mass index was <23 kg/m2, mean blood pressure at the time of inclusion was <135/85. SLQ in men improved significantly from -7.4± 9.9 to 7.9± 11.6 under female partner’s oxytocin use and 11.4 ± 14.0 under placebo (p < 0.04). Frequency of intercourse improved from 6.3 ± 3.9 at baseline to 7.3±4.0 under female oxytocin therapy, but not under placebo. Male satisfaction with orgasmduring intercourse improved significantly frombaseline 8.0±1.6 to 9.0±1.2 under oxytocin (p<0.04) anddecreased to5.2 ± 3.5 under placebo (p < 0.04). Male desire and arousal remained stable under female treatment. Evaluation of female partner’s performance by men improved significantly from 8.9 ± 2.8 at baseline to 10.6 ± 2.2 under oxytocin and to 11.2 ± 2.6 under placebo, respectively (p < 0.04). HDS in men improved from 1.5 ± 1.7 at baseline to 1.2± 2.6 (p1⁄4 0.07) under oxytocin, however decreased significantly under placebo (p < 0.04), especially when given oxytocin prior to placebo in women. Conclusion: Treatment of sexual dysfunction in female patients improves sexual quality of life, subjective evaluation of female sexual performance and depression in their male partners. Policy of full disclosure: None.

AB085. Systematic review and meta-analysis of phosphodiesterase type 5 inhibitors for the treatment of female sexual dysfunction

ObjectiveTo obtain systematic and comprehensive evidence regarding the benefits and safety of PDE5i compared to those of placebo.MethodsAll randomized controlled trials (RCTs) reporting on the effectiveness of PDE5i in FSD were identified through comprehensive searches of PubMed, the Cochrane Library and Embase, and a meta-analysis and systematic review of these studies were conducted.ResultsFourteen studies were included for meta-analysis. Because RCTs included in our study adopted different questionnaires for the measurement of sexual function, most of the data had to be separated rather than pooling the results. Summarizing the results of each comparison, we found that the use of PDE5i resulted in a significant improvement in sexual functioning compared with placebo in most studies, except for a few sporadic negative results. However, pooled data for adverse events showed significantly higher rates of headache, flushing, and vision changes in PDE5i treatment group [risk ratio (RR) 2.59, 95%95% confidence interval (CI), 1.93–3.47, P<0.00001; RR 5.74, 95% CI, 3.60–9.14, P<0.00001; and RR 4.64, 95% CI, 2.16–9.98, P<0.0001, respectively]. However, no one reported the need of any additional therapy for these adverse events.ConclusionsOur results indicate that PDE5i would be effective for female sexual dysfunction. Though there were significantly higher rates of adverse events, use of PDE5i was still relatively safe. More well-designed, double-blind, crossover RCTs reporting results from standardized questionnaires should be conducted to accurately solve this issue.

Role of Estrogens and Estrogen-Like Compounds in Female Sexual Function and Dysfunction.

Sex steroids are important in female sexual function and dysfunction. To review the role of estrogens in the physiology and pathophysiology of female sexual functioning and the evidence for efficacy of estrogen therapy for female sexual dysfunction to update the previously published International Society of Sexual Medicine Consensus on this topic. Panel members reviewed the published literature using online databases for studies pertaining to estrogen in female sexual function and dysfunction. Attention was specifically given to clinical trials that had reported on sexual function outcomes in women treated with estrogen. Quality of data published in the literature and recommendations were based on the GRADES system. Observational studies that have considered relationship factors and physical or mental health have reported that these factors contribute more to sexual functioning than menopausal status or estrogen levels. Few clinical trials have investigated estrogen therapy with sexual function as a primary outcome. The available data do not support systemic estrogen therapy for the treatment of female sexual dysfunction. Topical vaginal estrogen therapy improves sexual function in postmenopausal women with vulvovaginal atrophy (VVA) and is considered first-line treatment of VVA. Oral ospemifene, a selective estrogen receptor modulator, is effective for the treatment of VVA and might have independent systemic effects on female sexual function. For sexual problems, the treatment of VVA remains the most pertinent indication for estrogen therapy. When systemic symptoms are absent, estrogen therapy ideally can be administered by a vaginal preparation alone. Systemic estrogen therapy with combined estrogen and progestin in non-hysterectomized women is indicated for women who require treatment for vasomotor and/or other systemic estrogen deficiency symptoms. The improvement in well-being achieved by relief of vasomotor and other symptoms might improve libido in some women and abrogate further intervention.

Female Sexual Dysfunction: Is It a Treatable Disease?

Female sexual dysfunction affects approximately 40% of women (Sexual problems and distress in United States women: prevalence and correlates; Shifren et al., Obstet Gynecol, 112(5): 970-978, 2008). Due to its multi-factorial etiology, a wide variety of treatments are available that address specific symptoms, but no treatment exists that treats the overall disorder. Significant strides have recently been made in an effort to treat the plethora of symptoms associated with this disorder. The purpose of this article is to provide an overview of recent research on the available treatments for female sexual dysfunction. We discuss novel agents such as flibanserin, as well as various mechanical devices and hormonal treatments aimed at the specific subtypes of female sexual dysfunction.

Sexual dysfunction in 2015: Recovering sex drive in women - progress and opportunities.

In 2015, the approval of flibanserin opened a debate about diagnosis and treatment of female sexual dysfunction. Designing clinical trials with suitable end points is difficult, but some studies indicate correlations between hormone levels and low desire. New research demonstrates opportunities for a better understanding of this multifaceted condition.

Systematic review and meta-analysis of phosphodiesterase type 5 inhibitors for the treatment of female sexual dysfunction.

Clinical studies evaluating the effectiveness and safety of phosphodiesterase type 5 inhibitors (PDE5is) for female sexual dysfunction have reported conflicting results. To systematically review evidence from studies comparing PDE5is with placebo in the treatment of female sexual dysfunction. Searches of PubMed, the Cochrane Library, and Embase databases were performed using the MeSH terms "females/female/women", "sexual", and "sildenafil/tadalafil/vardenafil/PDE5/PDE5i". All randomized controlled trials, available in English, published no later than January 28, 2015 comparing the effectiveness of PDE5is, or PDE5is in combination with other agents, with placebo in improving female sexual function were included. The inclusion criteria were met by 14 studies, which were analyzed by two reviewers. The randomized controlled trials included in the present study adopted different questionnaires for measuring sexual function; consequently, most of the data had to be considered separately rather than pooled. Generally, the use of PDE5is resulted in significant improvements in sexual function compared with placebo, with some studies demonstrating negative results. Pooled data regarding adverse events demonstrated significantly higher rates of headache, flushing, and changes in vision in PDE5i-treated patients. PDE5is could be an effective treatment modality for female sexual dysfunction. Although there were significant increases in adverse events in comparison with placebo, PDE5is were still relatively safe.

Female sexual dysfunction is an artificial concept driven by commercial interests: FOR: FSD is a multimillion dollar business.

Female sexual dysfunction (FSD) can be classified as low sexual desire (diminished libido), sexual arousal disorder (difficulty to become aroused or maintain arousal during sexual activity), orgasmic disorder (persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and continuing stimulation), and sexual pain disorder (pain associated with sexual stimulation or vaginal contact). Prevalence data suggest that 10–42% of women experience orgasmic disorder, and that 15% of women report some pain during intercourse. If a woman has an orgasm through clitoral stimulation, but not during intercourse, it does not meet the criteria for a clinical diagnosis of female orgasmic disorder. If the orgasmic difficulties are the result of inadequate sexual stimulation, these cases should not be diagnosed as a disorder of female orgasm (American Psychiatric Association, American Psychiatric Publishing 2013). Questionnaires are used to establish the diagnosis and to assess the response to treatment of FSD. The female sexual function index (FSFI) questionnaire is the most widely used measure of FSD, and has been cited in more than 1500 articles; however, the validity of the FSFI has not been addressed in the literature (Forbes et al. J Sex Res 2014;51:485–91). Physiologically the FSFI does not provide an assessment of female sexual function as it contains mainly psychological terms (Rosen et al. J Sex Marital Ther 2000;26:191–208). The FSFI seems to assess the degree of lubrication and ease of penetration, whereas very little attention is paid to clitoral sensation. In fact, a decline in desire, and a decreased ability to achieve orgasm, is associated specifically with penile–vaginal intercourse. As a matter of fact, FSD as a concept is popular because it is based on something that doesn't exist, i.e. the vaginal orgasm. Female orgasm is caused by the female erectile organs and, physiologically, female sexual satisfaction is based on orgasm and resolution (Puppo Clin Anat 2013;26:134–52). Moynihan stated: ‘I described the making of female sexual dysfunction as the freshest, clearest example of the corporate sponsored creation of a disease…The 19 item female sexual function index, published in 2000, was supported by Bayer and Zonagen at a time they hoped to treat so-called arousal disorder. The sexual function questionnaire was funded by Pfizer, and half of the authors on the 2002 paper describing its development were Pfizer employees, including the lead author’ (Moynihan BMJ 2010;341:c5050). FSD has become the centre of a multimillion-dollar business, and seems to be essentially focused on sexual function resulting from penile–vaginal intercourse. The FSFI questionnaire must not be used to assess FSD. Is FSD an illness constructed by sexologists under the influence of drug companies? Questionnaires for the diagnosis and treatment of male and female sexual dysfunctions must mainly assess the presence or absence of orgasm (a function of the human body, which must be assessed in the subject) with masturbation, and the questions posed should not use the words ‘intercourse’ or ‘satisfaction’. None declared. Completed disclosure of interests form available to view online as supporting information.

Physical therapy in sexually dysfunctional women: a systematic review

The World Health Organization (WHO) considers Female Sexual Dysfunctions (FSDs) to be a public health issue. There are a multitude of disorders such as female sexual arousal disorder, hypoactive sexual desire disorder, orgasmic disorder, dyspareunia, and vaginismus. FSDs are detected in 67.9% of the women in the world and are present in 50% of Asians, in 30-50% of Americans, and in 30% of Brazilians. Objective: To systematically review the literature on the different physiotherapy techniques used in the treatment of FSDs. Methods: A systematic search was conducted in the databases EMBASE, PEDro, and MedLine in data as recent as June 2013, by combining words and descriptors of physical therapy treatments and female sexual dysfunctions. Excluded from review were articles concerning male sexual dysfunction, pilot studies, multicentric papers of projects, and those which were either not available in their entirety or were duplicated in another database. After the selection of studies was complete, the randomized clinical trials were scored on the PEDro Evaluation Scale. Results: Eleven articles were included, six of which went on to be qualitatively evaluated on the PEDro scale. The present study followed the methodological structure of PRISMA (Statement for Reporting Systematic Reviews and Meta-Analyses of Studies). All studies found used questionnaires to assess the effects of physical therapy on FSDs. A total of five different types of interventions were verified: kinesiotherapy (Kegel exercises and pelvic floor muscle training - PFMT), Cognitive behavioral therapy (CBT), biofeedback, electrotherapy (transcutaneous electrical stimulation - TENS, and therapeutic ultrasound - US), and manual therapy. The limitations found in this systematic review were related to the unavailability of the articles in full and the low methodological quality of the studies. Conclusion: All studies showed improvements in sexual function after physical therapy intervention. There is no consensus on any intervention with better results; however, kinesiotherapy using PFMT proved to be advantageous because of its easy application, low cost, easy learning curve, and lasting results achieved in a short period. However, there are methodological shortcomings that still need to be dealt with to determine the most suitable physical therapy treatment for FSDs, as well as defining the best dosage, the protocol to be followed, and the duration of therapy, as well as the best cost-benefit

Psychological treatment of female sexual dysfunction: a critical review of the literature

Impairment of sexual functioning may have a significant impact on the person's quality of life. Despite the high prevalence of female sexual dysfunctions, it is still not clear what are the effective treatments for these disorders. The aim of this critical review is to provide an update on the efficacy of psychological treatments for female sexual dysfunctions. A thorough literature search was performed, using electronic database (PubMed and PsychINFO) and manual searches, selecting articles in English and Italian language published in peer-reviewed journals. Only randomized controlled trials were included. Most of the studies investigated the efficacy of sex therapy using techniques developed by Masters and Johnson and behavioral/ cognitive-behavioral treatment programs. Both approaches were effective for dyspareunia and vaginismus. Cognitive-behavioral and mindfulness based therapy showed significant improvement in hypoactive sexual desire but more research is needed for this disorder. Studies on the efficacy of treatment for orgasmic disorder are scarce and dated and they investigated mainly behavioral programs. The low methodological quality of many studies and the paucity of data for the most prevalent female dysfunctions calls for further research on psychological interventions for these disorders, using randomized, controlled designs and larger samples.

Flibanserin: Approval of a controversial drug for a controversial disorder

Byline: T. Sathyanarayana Rao, Chittaranjan. Andrade Flibanserin (BIMT 17; Addyi; Sprout Pharmaceuticals, North Carolina, USA) is an agonist at postsynaptic (but not presynaptic) serotonin (5HT) 5HT1a receptors and an antagonist at 5HT2 receptors; the binding appears preferential for prefrontal cortex (PFC) pyramidal neurons that regulate monoamine release. Thus, flibanserin dosing results in increased release of dopamine (DA) and norepinephrine (NE) in the PFC. Flibanserin is also associated with decreased release of 5HT in the PFC, nucleus accumbens, and hypothalamus, but not hippocampus. Whereas DA and NE putatively increase sexual desire and arousal and 5HT inhibits sexual desire and arousal, this pharmacodynamic profile may explain the suggested benefits of the drug in women with hypoactive sexual desire disorder (HSDD). Weak and probably nonsignificant actions of flibanserin include antagonism at 5HT2b, 5HT2c, and D4 receptor sites.[sup][1],[2] Flibanserin was originally developed as an antidepressant [sup][3] with a potentially rapid onset of action;[sup][4] it was effective in some but not all animal models of depression.[sup][5] Phase 2 randomized controlled trials (RCTs) failed to find it effective against depression; however, interestingly, the drug outperformed placebo on responses to the question“how strong is your sex drive."[sup][3] On September 22, 2015, only 76 hits emerged in a PubMed search with the key word flibanserin, and only 9 hits emerged with the clinical trial search filter applied. The failed antidepressant data are unavailable in PubMed and presumably remain unpublished, but the sexual function findings have been released. Kennedy [sup][6] examined data from 4 RCTs of flibanserin (100–200 mg/day) in men ( n = 369) and women ( n = 523) with major depressive disorder. All RCTs had an active comparison treatment arm, and two RCTs were additionally placebo-controlled. Patients in the RCTs had been assessed using the Arizona Sexual Experiences Scale and the Hamilton Depression Rating Scale (HAM-D) genital symptoms item. In general, it appeared that flibanserin was associated with low or placebo-level risk of treatment-emergent sexual dysfunction. In one RCT, reported improvement in sexual functioning in women with baseline sexual dysfunction was 70% versus 30% for flibanserin versus placebo groups. In another RCT, flibanserin was associated with significantly greater improvement on the genital symptoms HAM-D item at weeks 4, 6, and 8. In the other RCTs, outcomes related to sexual functioning were inconsistent.[sup][6] Thus, there seemed to be a weak signal suggesting that flibanserin carries benefits for sexual functioning in women with depression. Four important RCTs and two long-term studies have now been published on the use of flibanserin for HSDD. HSDD is characterized by low sexual desire as a result of which the individual experiences distress or interpersonal difficulty. The condition is not diagnosed if the low desire is due to medications, substances of abuse, a co-existing medical or psychiatric condition, or relationship problems. HSDD is considered to be acquired when it arises in an individual who had normal sexual desire earlier; it is considered generalized when it is not specific to a type of sexual activity, a situation, or a partner.[sup][7] The four RCTs, with a somewhat sexist slant, were named after flowers: DAISY,[sup][8] VIOLET,[sup][9] BEGONIA,[sup][10] and SNOWDROP.[sup][11] All RCTs were 24 weeks studies, conducted in women with premenopausal HSDD. The mean age of the women was about 36 years, and the mean duration of HSDD was about 5 years. All women in these studies were generally healthy, and so the findings of safety and efficacy cannot be generalized to women with medical and neuropsychiatric conditions, especially those receiving psychotropic drugs. The major outcomes were assessed in the last 4 weeks of treatment relative to baseline. …